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Other Review Entities

Type of Review

Contractor

Brief Description

Comprehensive Error Rate Testing (CERT)

AdvanceMed and Livanta

CERT was established by CMS to monitor and report the accuracy of Medicare Fee-For-Service (FFS) payments. It calculates the paid claims error rate for Medicare claims submitted to Part A, Part B and DME MACs.

Office of Inspector General (OIG)

OIG

The OIG's duties are carried out through a nationwide network of audits, investigations, inspections and other mission-related functions performed by OIG components. (Public Law 95-452 (as amended)).

Recovery Auditor


Performant Recovery

The Recovery Auditor detects and corrects past improper payments so that CMS, claims processing contractors, and suppliers can implement actions that will prevent future improper payments.

Supplemental Medical Review Contractor (SMRC) StrategicHealthSolutions, LLC The SMRC does nationwide medical review for all types of Medicare claims, including DME claims, as directed by CMS.

Program Safeguard Contractor (PSC)

 

Program Safeguard Contractors (PSCs) were created to perform program integrity functions. The primary goal of PSCs is to investigate instances of suspected fraud, waste, and abuse.

 

Last Updated Jun 17, 2016